title: Response of pediatric uveitis to tumor necrosis factor-α inhibitors.
abstract: OBJECTIVE
  To evaluate the outcome of tumor necrosis factor-α inhibition (anti-TNF) for pediatric uveitis.
  
  
  METHODS
  We retrospectively assessed children (age ≤ 18 yrs) with noninfectious uveitis receiving anti-TNF at 5 uveitis centers and 1 pediatric rheumatology center. Incident treatment success was defined as minimal or no uveitis activity at ≥ 2 consecutive ophthalmological examinations ≥ 28 days apart while taking no oral and ≤ 2 eyedrops/day of corticosteroids. Eligible children had active uveitis and/or were taking higher corticosteroid doses.
  
  
  RESULTS
  Among 56 eligible children followed over 33.73 person-years, 52% had juvenile idiopathic arthritis (JIA) and 75% had anterior uveitis (AU). The Kaplan-Meier estimated proportion achieving treatment success within 12 months was 75% (95% CI 62%-87%). Complete absence of inflammatory signs with discontinuation of all corticosteroids was observed in an estimated 64% by 12 months (95% CI 51%-76%). Diagnoses of JIA or AU were associated with greater likelihood of success, as was the oligoarticular subtype among JIA cases. In a multivariable model, compared to those with JIA-associated AU, those with neither or with JIA or AU alone had a 75%-80% lower rate of achieving quiescence under anti-TNF, independent of the number of immunomodulators previously or concomitantly prescribed. Uveitis reactivated within 12 months of achieving quiescence in 14% of those continuing anti-TNF (95% CI 6%-31%). The incidence of discontinuation for adverse effects was 8%/year (95% CI 1%-43%).
  
  
  CONCLUSIONS
  Treatment with anti-TNF was successful and sustained in a majority of children with noninfectious uveitis, and treatment-limiting toxicity was infrequent. JIA-associated AU may be especially responsive to anti-TNF.
authors.affiliation: Division of Rheumatology, The Children's Hospital of Philadelphia (CHOP), Philadelphia, Pennsylvania 19104, USA. lermanm@email.chop.edu
authors.forename: Melissa A
authors.initials: MA
authors.lastname: Lerman
authors.forename: Jon M
authors.initials: JM
authors.lastname: Burnham
authors.forename: Peter Y
authors.initials: PY
authors.lastname: Chang
authors.forename: Ebenezer
authors.initials: E
authors.lastname: Daniel
authors.forename: C Stephen
authors.initials: CS
authors.lastname: Foster
authors.forename: Sean
authors.initials: S
authors.lastname: Hennessy
authors.forename: Douglas A
authors.initials: DA
authors.lastname: Jabs
authors.forename: Marshall M
authors.initials: MM
authors.lastname: Joffe
authors.forename: R Oktay
authors.initials: RO
authors.lastname: Kaçmaz
authors.forename: Grace A
authors.initials: GA
authors.lastname: Levy-Clarke
authors.forename: Monte D
authors.initials: MD
authors.lastname: Mills
authors.forename: Robert B
authors.initials: RB
authors.lastname: Nussenblatt
authors.forename: James T
authors.initials: JT
authors.lastname: Rosenbaum
authors.forename: Eric B
authors.initials: EB
authors.lastname: Suhler
authors.forename: Jennifer E
authors.initials: JE
authors.lastname: Thorne
authors.forename: John H
authors.initials: JH
authors.lastname: Kempen
mesh_terms: D000068879:Adalimumab; D000293:Adolescent; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use*; D001171:Arthritis, Juvenile / Q000188:drug therapy / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D015897:Comorbidity; D000068800:Etanercept; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000627:therapeutic use*; D007223:Infant; D000069285:Infliximab; D053208:Kaplan-Meier Estimate; D008297:Male; D018124:Receptors, Tumor Necrosis Factor / Q000627:therapeutic use*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*; D014605:Uveitis / Q000188:drug therapy* / Q000453:epidemiology; D014606:Uveitis, Anterior / Q000188:drug therapy* / Q000453:epidemiology
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D007074:Immunoglobulin G; D018124:Receptors, Tumor Necrosis Factor; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab; D000068879:Adalimumab; D000068800:Etanercept
keywords: JUVENILE IDIOPATHIC ARTHRITIS; TUMOR NECROSIS FACTOR ANTAGONIST; UVEITIS